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up to dinner in the ward. Nothing more was seen of theligatures.SMASHED HAND ; ATTEMPTED CONSERVATIVE SURGERY" ;

GANGRENE OF FLAPS, WITH INFILTRATION ABOUT

WRIST ; RE-AMPUTATION IN FOREARM.

(Under the care of Mr. LUPTON.)William C-, aged forty-seven, an army pensioner,

twenty-one years’ service, including the Mutiny and mucharduous service, was admitted on November 8th, 1880,suffering from a smash, caused by a trolly-wheel passingover his hand. The thumb and second, third, and fourthfingers were completely smashed, and their integumentsdestroyed. The index finger had escaped. There seemed achance of saving this ; accordingly the thumb, with itsmetacarpal bone, and the remaining three fingers, were re-moved. The flaps formed, however, were too seriouslyinjured, and sloughed, the whole assuming an unhealthyand gangrenous appearance, while the integuments ahoutthe wrist were infiltrated and " boggy," and the patientsuffered constitutionally. Consequently, on Nov. 16thMr. Lupton re-amputated in the lower third of the fore-arm, cutting skin. flaps clear of the infiltrated area, anddividing the deeper parts by circular incision. The remainingtreatment was precisely that of the former case; and thesubsequent progress of this case was also satisfactory, thepatient leaving the infirmary with a sound stump on

February 1st, 1881. ___________

KASHMIR HOSPITAL.A PULSATING BRONCHOCELE ; LIGATURE OF THE VESSELS;

RELIEF.

(Under the care of Dr. DOWNES.)IN August, 1877, a boy aged about ten, having a large

bronchocele, applied at the hospital. His appearance was

altogether peculiar; he was rather deaf and slightly idiotic.The goitre was enormous, quite as big as the boy’s head, andon both sides of the neck at the upper part of the tumourwere arteries which pulsated forcibly. The vessels stoodout on the surface of the tumour and pulsated with suchforce as to make the whole tumour move ; the artery on theright side was much more distinct than the one on the left.It was resolved to tie these two arteries. The operation wasmuch more difficult than had been anticipated, but wasfacilitated by the assistance of Drs. Williams and Ross ofthe Indian Medical Service. The patient was put underchloroform, and an incision was made about two inches anda half long through the skin over the pulsating artery onthe right side from a point near the angle of the jaw,directly downwards, and the fascia divided carefully with adirector. Here the difficulty began. The lobules of the hyper-trophied gland were soon encountered, then with a directorand the handle of the scalpel progress was very slowlymade till the artery, which was accompanied by a largevein, was seen. The artery, notwithstanding its superficialappearance, was really at a great depth. An aneurismneedle was placed under it, and the vessel tied with a stoutsilk ligature, leaving one end hanging out of the wound.The wound was closed with a couple of sutures, and thena similar operation was done on the other side. Nextday the patient was feeling pretty comfortable, and therewas no pulsation; after about three days severe feverset in suddenly; his temperature rose to 105° F. This hightemperature was brought down to normal by a few doses often grains of salicylrc acid. For two or three days thetemperature rose again, but was always brought down inthe same way. Every day the tumour was reduced in size ;on about the eighth day it was only half its original dimen-sions. He then asked permission to leave the hospital, buthe was urged not to go, at any rate until the ligatures hadseparated. However, on about the tenth day he ran awayat night, carrying the ligatures with him. Two years after-wards this bay was said to be still alive, and the goitre tohave quite disappeared.Remarks by Dr. DOWNES.—Whether the above infor-

mation be true or not, the fact that on about the tenthday the tumour was only half its original size, encouragesone to think that wherever a very large goitre exists with

pulsating arteries, a cure mav be (.bta;ned by tying thearteries in the way above described. The operation is,however, somewhat troublesome, and not without danger.Such a high temperature is uncommon here after even verysevere operations.

Medical Societies.PATHOLOGICAL SOCIETY OF LONDON.

Eczema of the Nipple and Cancer of the Mamma.—CysticDegeneration of Breast.—Cystic Disease of Kidneys andLiver.-Cystic Disease of Fœtal Ovary.—Cancer ofMediastinal Glands. - Localised Pneumothorax.—AorticDisease.—Pulmonary Thrombosis.—Uterine Polypus.-Malformation of Hand.THE ordinary meeting of the Pathological Society of

London was held on Tuesday, March 15th, Samuel Wilks,M.D., F,R.S., in the chair.

Dr. THIN showed specimens from and gave an account oftwo cases in which long-standing Disease of the Nipple andAreola was followed by the development of tumours in thebreast. The first case was that of a single woman, agedforty-nine, whose breast was removed by Mr. Henry Morris.The nipple had been irritated for some weeks by a needle inthe woman’s stays six years previously to the tumour beingobserved. The irritation set up had never healed, and atthe time of operation the position of the areola was markedby a bright red, moist surface two inches in diameter, a de-pression in the centre indicating where the nipple had been.The margin of this surface was sharply marked off from thehealthy skin. On microscopical examination it was foundthat the centre of this area was denuded of epithelium, thecancerous growth forming the surface of a superficial ulcer.On the outer part of the area the epithelium was entire, butthickened, with elongated papillae. The papillary layer ofconnective tissue was here destroyed, and the space itshould have occupied was filled with exudation cells. Thedistinguishing features of the breast tumour were an exces-sive development of fibrous tissue and rounded clusters ofcells, with a columnar epithelium lining the cavities inwhich they lay. On the edge of the growth the newepithelium was seen as small round columns with a centrallumen, the condition termed by some pathologists adeno-fibroma. In the second case the breast was removed byMr. George Lawson. The patient, an unmarried woman,aged fifty-seven, had suffered from the nipple affection forupwards of a year. There was no pain in the breast, noperceptible tumour, and no enlargement of the axillaryglands. In the diseased skin in this case the epidermis was

’ entire, but thickened, with long papillæ. The papillarylayer of connective tissue had disappeared, and a stratumof exudation cells had taken its place. The breast consistedof a large mass of fat., permeated with narrow streaks offibrous tissue. In these streaks a new epithelial growth wasfound in the form of tubes and round cell-clusters, with,small cells and a distinct border of columnar epithelium.The narrow strips of fibrous tissue always separated theepithelial growth from direct contact with the fat lobules ofwhich the large breast was almost entirely composed. Thetumour would probably be called an adeno-lipoma. Thesetwo cases completed six which Dr. Thin had examined.Although these six cases all differ from each other insome respects, they agree in some essential points, and onthese points of agreement Dr. Thin concludes that theaffection of the nipple is neither eczema nor psoriasis, norany known specific skin disease. It is a destructivepapillary dermatitis, and he proposes that it shouldbe called malignant papillary dermatitis. The breasttumours take their origin from the epithelium of thelactiferous ducts, and retain the specific characters ofthat epithelium. A complete account of an instanceof the scirrhus, or parenchymatous type of cancer in con-nexion with this affection, has not yet been published. Alocal affection of the points on the surface of the nipple,which correspond to the mouths of the lactiferous ducts, haspreceded in cases which have been well observed the exten-